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17 September 2021
In a 2021 study published in the Clinical Kidney Journal, Dr Yang Xu* and colleagues help to shed light on the incidence of secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD) and the susceptibility of SHPT patients to adverse health-related outcomes.1
Looking at data from the Stockholm Creatinine Measurements (SCREAM) project, the goals of the study were to:1
An evaluation was made of all adults who:1
After identifying incidences of subsequent SHPT development, the incidences were characterised by estimated glomerular filtration rate (eGFR), and the association between SHPT and the adverse outcomes of interest were quantified.1
Incidences of SHPT were identified based on either a diagnosis being made, a treatment (calcimimetics or active vitamin D) being initiated, parathyroidectomy being performed and/or two consecutive parathyroid hormone (PTH) tests ≥130 pg/mL being encountered.1
The incidence of SHPT increased with CKD stage1
A total of 2,556 CKD patients were included in the analysis.1
During a median follow-up of 2.4 years, 784 (31%) of the patients developed SHPT, with an overall incidence of 114.9 per 1,000 person-years.1
The incidence of SHPT increased with CKD progression, highlighting a strong inverse relationship between eGFR and SHPT risk (Table 1).1,2
Adapted from Xu Y et al. 2021.2
SHPT increased the risks of all four investigated adverse outcomes1
After multivariable adjustment, the development of SHPT was associated with an increased risk of death, fractures, MACEs and CKD progression (Figure 1).1
HR: hazard ratio; RR: rate ratio.
Adapted from Xu Y et al. 2021.1
These findings expand on previous studies that produced similar results regarding the negative impact of SHPT on mortality,3,4 fractures,3 cardiovascular events3 and CKD progression.4
These findings not only illustrate the burden of SHPT in CKD but can also be used to inform clinical decisions regarding pre-SHPT risk stratification, PTH monitoring and risk-prevention strategies post-SHPT development.1
To read the full paper by Dr Xu and colleagues and evaluate the clinical implications of the results, please refer to the Clinical Kidney Journal website.
Footnotes and references
*Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
1. Xu Y et al. Clin Kidney J. 2021;sfab006.
2. Xu Y et al. Clin Kidney J. 2021;sfab006. Supplementary information.
3. Geng S et al. Osteoporos Int. 2019;30:2019–25.
4. Schumock GT et al. Curr Med Res Opin. 2008;24:3037–48.
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